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Health 2020

Monday 22 November, 2021

When we first started this study in 1990, we named it Health 2000 to highlight its future-facing aspect. Then 2000 went by, and so we renamed it Health 2020. Now that this once-futuristic date is our present, we thought we’d take the opportunity to celebrate this milestone by telling the story of Health 2020’s evolution through its first 30 years and the study’s contribution to cancer research.

How it started

Health 2020 was the flagship research platform for the newly formed Cancer Epidemiology Centre at Cancer Council Victoria. Dr Nigel Gray, former Cancer Council Victoria CEO, intended that this research take advantage of the organisation's long-term stewardship of the Victorian Cancer Registry.

When Health 2020 was conceived, the study design was shaped by research that showed that migrants from Southern Europe were less likely to be affected by certain cancers. At the time diet and nutrition were considered important to cancer causation, but there was little detailed information that would be adequate to inform prevention.

Health 2020 actively recruited migrants from Southern European migrant communities in Melbourne with nearly a quarter of participants born in Italy or Greece to understand whether aspects of their diet and lifestyle reduced the risk of certain types of cancer.

Our original research proposal encompassed a broad range of questions, with a strong focus on the influence of individual foods and food groups on the risk of cancer. To this end we also stored blood samples collected for analysis of dietary markers detectable in the blood.

To enable research on heart disease and diabetes as well as cancer, we also took direct physical and clinical measurements of all participants.

How it changed

As we addressed our research questions over time, we adapted our data collection at each participant follow-up to refine our approach and better answer remaining questions.

We also repeated blood sampling and collecting physical measurements to assess any changes over time. What we did not anticipate at the study’s inception was the rapid growth in genomic technology and knowledge. Health 2020 blood samples, which we originally collected solely to measure dietary and other markers, became a highly valuable source of DNA to examine genetic risk factors for disease. This field of research has been our principal focus for the past 15 years.

What we found

Health 2020 has contributed to over 900 scientific publications (and counting!). The most influential papers have come from pooling data with other cohorts in national and international consortia. Examples include the findings that overweight and obesity are associated with increased risk of many cancers; and the identification of common genetic variants associated with risk of breast, bowel and prostate cancer.

Other examples include findings contributing to our understanding of how the effects of modifiable risk factors combine to influence our risk of bowel cancer. Australia has one of the highest rates of bowel cancer in the world. About 1 in 13 Australians will be diagnosed with bowel cancer in their lifetime, and the risk increases as we age.

We know that our diet and other lifestyle-related factors can affect our chances of developing bowel cancer: being physically active and maintaining a healthy diet, including eating enough whole grains are all known to lower bowel cancer risk.

Associate Professor Robert MacInnis and Professor Graham Giles, looked at data provided by over 360,000 participants in seven Australian studies, including Health 2020, to see how combinations of these modifiable risk factors affected bowel cancer risk.

By analysing the rates of bowel cancer across ten years, the researchers found that overweight men who were also smokers and also drank too much alcohol were at significantly increased risk of bowel cancer.

A quarter of all the cases of bowel cancer in Australia can be attributed to these combined effects of smoking, being overweight or obese, and drinking too much alcohol. An effect of smoking on this combined risk remained even after men had quit smoking.

The findings of this analysis show that many bowel cancers could be prevented by modifying risk behaviours, especially for men. The findings also highlight the need for health educators and policymakers to make efforts to persuade men who are current or former smokers to cut down on their drinking.

Moving forward

All of these studies are good examples of the value of long-term cohort studies. Decades after the study’s commencement, the data provided by Health 2020 participants are still providing new insights into the causes of disease. Health 2020 continues to be a valuable resource, both for our own research as well as for collaborative studies with Australian and international research groups. Looking ahead, Health 2020 has been joined by the Australian Breakthrough Cancer (ABC) Study as a critical resource for research into the causes of cancer and other diseases.

The ABC Study started in 2014 as a contemporary, comprehensive, high-quality resource for national and international research into how to prevent cancer and other diseases.

Over the next 20-30 years, the ABC Study will follow more than 51,000 Australians to see who develops diseases such as cancer and identify what factors might be involved. Using the latest technologies, the study will investigate the role that our genes, lifestyle and environment play in the development of disease.